|
BLADDER CALCULUS REMOVAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959846
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BLADDER DILATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959847
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BLADDER DILATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959847
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Bladder Instillation of Anticarcinogenic Agent 51720
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
1188983
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$593.79 |
| Rate for Payer: Aetna Commercial |
$593.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$537.53
|
| Rate for Payer: Aetna Managed Medicare |
$36.69
|
| Rate for Payer: Anthem Medicare Advantage |
$36.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.69
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$593.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.69
|
| Rate for Payer: Health EOS Commercial |
$568.79
|
| Rate for Payer: HFN Commercial |
$593.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.69
|
| Rate for Payer: Multiplan Commercial |
$500.03
|
| Rate for Payer: NAPHCARE Commercial |
$55.04
|
| Rate for Payer: Preferred Network Access Commercial |
$593.79
|
| Rate for Payer: Quartz Beloit One Network |
$275.02
|
| Rate for Payer: Quartz Commercial |
$356.27
|
| Rate for Payer: Quartz Medicare Advantage |
$36.69
|
| Rate for Payer: The Alliance Commercial |
$155.94
|
| Rate for Payer: United Healthcare Medicaid |
$34.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.69
|
| Rate for Payer: WEA Trust Commercial |
$343.77
|
| Rate for Payer: WPS Commercial |
$165.11
|
|
|
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 51720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.82 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$733.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$733.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$733.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$733.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,729.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$733.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$733.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$733.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.74
|
| Rate for Payer: Quartz Medicare Advantage |
$733.82
|
| Rate for Payer: The Alliance Commercial |
$2,935.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$733.82
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$733.82
|
|
|
Bladder Irrigation, lavage 51700
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
1188984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$25.24
|
| Rate for Payer: Anthem Medicare Advantage |
$25.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.24
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$414.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.24
|
| Rate for Payer: Health EOS Commercial |
$397.49
|
| Rate for Payer: HFN Commercial |
$414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.24
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$37.86
|
| Rate for Payer: Preferred Network Access Commercial |
$414.96
|
| Rate for Payer: Quartz Beloit One Network |
$192.19
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: Quartz Medicare Advantage |
$25.24
|
| Rate for Payer: The Alliance Commercial |
$107.27
|
| Rate for Payer: United Healthcare Medicaid |
$19.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.24
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$113.58
|
|
|
BLADDER SLING ADVANTAGE FIT MID-URETHRA 850-2110 M0068502110
|
Facility
|
IP
|
$7,638.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3838943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,892.32 |
| Max. Negotiated Rate |
$7,308.04 |
| Rate for Payer: Aetna Commercial |
$7,149.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,831.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,210.07
|
| Rate for Payer: Cash Price |
$2,291.40
|
| Rate for Payer: Cigna Commercial |
$7,308.04
|
| Rate for Payer: Health EOS Commercial |
$7,069.73
|
| Rate for Payer: HFN Commercial |
$7,308.04
|
| Rate for Payer: Multiplan Commercial |
$6,354.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,308.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,892.32
|
| Rate for Payer: Quartz Commercial |
$4,766.11
|
| Rate for Payer: WEA Trust Commercial |
$4,368.94
|
| Rate for Payer: WPS Commercial |
$5,883.55
|
|
|
BLADDER SLING ADVANTAGE FIT MID-URETHRA 850-2110 M0068502110
|
Facility
|
OP
|
$7,638.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3838943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,224.19 |
| Max. Negotiated Rate |
$7,308.04 |
| Rate for Payer: Aetna Commercial |
$7,149.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,831.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,224.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,163.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,971.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,812.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,210.07
|
| Rate for Payer: Cash Price |
$2,291.40
|
| Rate for Payer: Cigna Commercial |
$7,308.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,445.32
|
| Rate for Payer: Health EOS Commercial |
$7,069.73
|
| Rate for Payer: HFN Commercial |
$7,308.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,957.64
|
| Rate for Payer: Multiplan Commercial |
$6,354.82
|
| Rate for Payer: NAPHCARE Commercial |
$4,766.11
|
| Rate for Payer: Preferred Network Access Commercial |
$7,308.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,892.32
|
| Rate for Payer: Quartz Commercial |
$5,163.29
|
| Rate for Payer: Quartz Medicare Advantage |
$4,766.11
|
| Rate for Payer: The Alliance Commercial |
$3,971.76
|
| Rate for Payer: WEA Trust Commercial |
$4,368.94
|
| Rate for Payer: WPS Commercial |
$5,883.55
|
|
|
BLADDER SLING ADVANTAGE MID-URETHRA 850-200 M0068502000
|
Facility
|
OP
|
$7,355.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
4519463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,141.78 |
| Max. Negotiated Rate |
$7,037.26 |
| Rate for Payer: Aetna Commercial |
$6,884.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,578.31
|
| Rate for Payer: Aetna Managed Medicare |
$2,141.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,971.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,824.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,671.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,054.08
|
| Rate for Payer: Cash Price |
$2,206.50
|
| Rate for Payer: Cigna Commercial |
$7,037.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,280.61
|
| Rate for Payer: Health EOS Commercial |
$6,807.79
|
| Rate for Payer: HFN Commercial |
$7,037.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,736.90
|
| Rate for Payer: Multiplan Commercial |
$6,119.36
|
| Rate for Payer: NAPHCARE Commercial |
$4,589.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,037.26
|
| Rate for Payer: Quartz Beloit One Network |
$3,748.11
|
| Rate for Payer: Quartz Commercial |
$4,971.98
|
| Rate for Payer: Quartz Medicare Advantage |
$4,589.52
|
| Rate for Payer: The Alliance Commercial |
$3,824.60
|
| Rate for Payer: WEA Trust Commercial |
$4,207.06
|
| Rate for Payer: WPS Commercial |
$5,665.56
|
|
|
BLADDER SLING ADVANTAGE MID-URETHRA 850-200 M0068502000
|
Facility
|
IP
|
$7,355.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
4519463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,748.11 |
| Max. Negotiated Rate |
$7,037.26 |
| Rate for Payer: Aetna Commercial |
$6,884.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,578.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,054.08
|
| Rate for Payer: Cash Price |
$2,206.50
|
| Rate for Payer: Cigna Commercial |
$7,037.26
|
| Rate for Payer: Health EOS Commercial |
$6,807.79
|
| Rate for Payer: HFN Commercial |
$7,037.26
|
| Rate for Payer: Multiplan Commercial |
$6,119.36
|
| Rate for Payer: Preferred Network Access Commercial |
$7,037.26
|
| Rate for Payer: Quartz Beloit One Network |
$3,748.11
|
| Rate for Payer: Quartz Commercial |
$4,589.52
|
| Rate for Payer: WEA Trust Commercial |
$4,207.06
|
| Rate for Payer: WPS Commercial |
$5,665.56
|
|
|
BLADDER SLING LYNX MIDURETHRAL 850-300
|
Facility
|
IP
|
$6,618.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2964826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,372.53 |
| Max. Negotiated Rate |
$6,332.10 |
| Rate for Payer: Aetna Commercial |
$6,194.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,919.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,647.84
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cigna Commercial |
$6,332.10
|
| Rate for Payer: Health EOS Commercial |
$6,125.62
|
| Rate for Payer: HFN Commercial |
$6,332.10
|
| Rate for Payer: Multiplan Commercial |
$5,506.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,332.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,372.53
|
| Rate for Payer: Quartz Commercial |
$4,129.63
|
| Rate for Payer: WEA Trust Commercial |
$3,785.50
|
| Rate for Payer: WPS Commercial |
$5,097.85
|
|
|
BLADDER SLING LYNX MIDURETHRAL 850-300
|
Facility
|
OP
|
$6,618.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2964826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,927.16 |
| Max. Negotiated Rate |
$6,332.10 |
| Rate for Payer: Aetna Commercial |
$6,194.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,919.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,927.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,473.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,441.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,303.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,647.84
|
| Rate for Payer: Cash Price |
$1,985.40
|
| Rate for Payer: Cigna Commercial |
$6,332.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,851.68
|
| Rate for Payer: Health EOS Commercial |
$6,125.62
|
| Rate for Payer: HFN Commercial |
$6,332.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,162.04
|
| Rate for Payer: Multiplan Commercial |
$5,506.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,129.63
|
| Rate for Payer: Preferred Network Access Commercial |
$6,332.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,372.53
|
| Rate for Payer: Quartz Commercial |
$4,473.77
|
| Rate for Payer: Quartz Medicare Advantage |
$4,129.63
|
| Rate for Payer: The Alliance Commercial |
$3,441.36
|
| Rate for Payer: WEA Trust Commercial |
$3,785.50
|
| Rate for Payer: WPS Commercial |
$5,097.85
|
|
|
BLADDER SLING OBTRYX II HALO TAPE 850-511
|
Facility
|
OP
|
$8,081.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3219463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,353.19 |
| Max. Negotiated Rate |
$7,731.90 |
| Rate for Payer: Aetna Commercial |
$7,563.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,227.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,353.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,462.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,202.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,034.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,454.25
|
| Rate for Payer: Cash Price |
$2,424.30
|
| Rate for Payer: Cigna Commercial |
$7,731.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,703.14
|
| Rate for Payer: Health EOS Commercial |
$7,479.77
|
| Rate for Payer: HFN Commercial |
$7,731.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,303.18
|
| Rate for Payer: Multiplan Commercial |
$6,723.39
|
| Rate for Payer: NAPHCARE Commercial |
$5,042.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,731.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,118.08
|
| Rate for Payer: Quartz Commercial |
$5,462.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5,042.54
|
| Rate for Payer: The Alliance Commercial |
$4,202.12
|
| Rate for Payer: WEA Trust Commercial |
$4,622.33
|
| Rate for Payer: WPS Commercial |
$6,224.79
|
|
|
BLADDER SLING OBTRYX II HALO TAPE 850-511
|
Facility
|
IP
|
$8,081.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
3219463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,118.08 |
| Max. Negotiated Rate |
$7,731.90 |
| Rate for Payer: Aetna Commercial |
$7,563.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,227.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,454.25
|
| Rate for Payer: Cash Price |
$2,424.30
|
| Rate for Payer: Cigna Commercial |
$7,731.90
|
| Rate for Payer: Health EOS Commercial |
$7,479.77
|
| Rate for Payer: HFN Commercial |
$7,731.90
|
| Rate for Payer: Multiplan Commercial |
$6,723.39
|
| Rate for Payer: Preferred Network Access Commercial |
$7,731.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,118.08
|
| Rate for Payer: Quartz Commercial |
$5,042.54
|
| Rate for Payer: WEA Trust Commercial |
$4,622.33
|
| Rate for Payer: WPS Commercial |
$6,224.79
|
|
|
BLADDER SLING OBTRYX TAPE 850-500
|
Facility
|
IP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2975074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,745.56 |
| Max. Negotiated Rate |
$7,032.48 |
| Rate for Payer: Aetna Commercial |
$6,879.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,573.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,051.32
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Cigna Commercial |
$7,032.48
|
| Rate for Payer: Health EOS Commercial |
$6,803.16
|
| Rate for Payer: HFN Commercial |
$7,032.48
|
| Rate for Payer: Multiplan Commercial |
$6,115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,032.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,745.56
|
| Rate for Payer: Quartz Commercial |
$4,586.40
|
| Rate for Payer: WEA Trust Commercial |
$4,204.20
|
| Rate for Payer: WPS Commercial |
$5,661.70
|
|
|
BLADDER SLING OBTRYX TAPE 850-500
|
Facility
|
OP
|
$7,350.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2975074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,140.32 |
| Max. Negotiated Rate |
$7,032.48 |
| Rate for Payer: Aetna Commercial |
$6,879.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,573.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,140.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,968.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,822.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,669.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,051.32
|
| Rate for Payer: Cash Price |
$2,205.00
|
| Rate for Payer: Cigna Commercial |
$7,032.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,277.70
|
| Rate for Payer: Health EOS Commercial |
$6,803.16
|
| Rate for Payer: HFN Commercial |
$7,032.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,733.00
|
| Rate for Payer: Multiplan Commercial |
$6,115.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,586.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,032.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,745.56
|
| Rate for Payer: Quartz Commercial |
$4,968.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,586.40
|
| Rate for Payer: The Alliance Commercial |
$3,822.00
|
| Rate for Payer: WEA Trust Commercial |
$4,204.20
|
| Rate for Payer: WPS Commercial |
$5,661.70
|
|
|
BLADDER SLING PROCEDURE
|
Facility
|
IP
|
$4,383.00
|
|
| Hospital Charge Code |
2959848
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,233.58 |
| Max. Negotiated Rate |
$4,193.65 |
| Rate for Payer: Aetna Commercial |
$4,102.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,415.91
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,193.65
|
| Rate for Payer: Health EOS Commercial |
$4,056.90
|
| Rate for Payer: HFN Commercial |
$4,193.65
|
| Rate for Payer: Multiplan Commercial |
$3,646.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,193.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,233.58
|
| Rate for Payer: Quartz Commercial |
$2,734.99
|
| Rate for Payer: WEA Trust Commercial |
$2,507.08
|
| Rate for Payer: WPS Commercial |
$3,376.22
|
|
|
BLADDER SLING PROCEDURE
|
Facility
|
OP
|
$4,383.00
|
|
| Hospital Charge Code |
2959848
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.33 |
| Max. Negotiated Rate |
$4,193.65 |
| Rate for Payer: Aetna Commercial |
$4,102.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,920.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,962.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,279.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,187.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,415.91
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,193.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,550.91
|
| Rate for Payer: Health EOS Commercial |
$4,056.90
|
| Rate for Payer: HFN Commercial |
$4,193.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,418.74
|
| Rate for Payer: Multiplan Commercial |
$3,646.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,734.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,193.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,233.58
|
| Rate for Payer: Quartz Commercial |
$2,962.91
|
| Rate for Payer: Quartz Medicare Advantage |
$2,734.99
|
| Rate for Payer: The Alliance Commercial |
$2,279.16
|
| Rate for Payer: WEA Trust Commercial |
$2,507.08
|
| Rate for Payer: WPS Commercial |
$3,376.22
|
|
|
BLADDER SLING TVT GYNECARE RETROPUBIC TENSION-FREE MESH MECHANICAL CUT 810041B
|
Facility
|
IP
|
$7,953.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
5384772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,052.85 |
| Max. Negotiated Rate |
$7,609.43 |
| Rate for Payer: Aetna Commercial |
$7,444.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,113.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,383.69
|
| Rate for Payer: Cash Price |
$2,385.90
|
| Rate for Payer: Cigna Commercial |
$7,609.43
|
| Rate for Payer: Health EOS Commercial |
$7,361.30
|
| Rate for Payer: HFN Commercial |
$7,609.43
|
| Rate for Payer: Multiplan Commercial |
$6,616.90
|
| Rate for Payer: Preferred Network Access Commercial |
$7,609.43
|
| Rate for Payer: Quartz Beloit One Network |
$4,052.85
|
| Rate for Payer: Quartz Commercial |
$4,962.67
|
| Rate for Payer: WEA Trust Commercial |
$4,549.12
|
| Rate for Payer: WPS Commercial |
$6,126.20
|
|
|
BLADDER SLING TVT GYNECARE RETROPUBIC TENSION-FREE MESH MECHANICAL CUT 810041B
|
Facility
|
OP
|
$7,953.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
5384772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,315.91 |
| Max. Negotiated Rate |
$7,609.43 |
| Rate for Payer: Aetna Commercial |
$7,444.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,113.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,315.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,376.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,135.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,970.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,383.69
|
| Rate for Payer: Cash Price |
$2,385.90
|
| Rate for Payer: Cigna Commercial |
$7,609.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,628.65
|
| Rate for Payer: Health EOS Commercial |
$7,361.30
|
| Rate for Payer: HFN Commercial |
$7,609.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,203.34
|
| Rate for Payer: Multiplan Commercial |
$6,616.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,962.67
|
| Rate for Payer: Preferred Network Access Commercial |
$7,609.43
|
| Rate for Payer: Quartz Beloit One Network |
$4,052.85
|
| Rate for Payer: Quartz Commercial |
$5,376.23
|
| Rate for Payer: Quartz Medicare Advantage |
$4,962.67
|
| Rate for Payer: The Alliance Commercial |
$4,135.56
|
| Rate for Payer: WEA Trust Commercial |
$4,549.12
|
| Rate for Payer: WPS Commercial |
$6,126.20
|
|
|
BLADDER SLING TVT GYNECARE RETROPUBIC TENSION-FREE SUPPORT WITH ABDOMINAL GUIDE 810041A
|
Facility
|
OP
|
$7,843.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2965768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,283.88 |
| Max. Negotiated Rate |
$7,504.18 |
| Rate for Payer: Aetna Commercial |
$7,341.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,014.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,283.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,301.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,078.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,915.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,323.06
|
| Rate for Payer: Cash Price |
$2,352.90
|
| Rate for Payer: Cigna Commercial |
$7,504.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,564.63
|
| Rate for Payer: Health EOS Commercial |
$7,259.48
|
| Rate for Payer: HFN Commercial |
$7,504.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,117.54
|
| Rate for Payer: Multiplan Commercial |
$6,525.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,894.03
|
| Rate for Payer: Preferred Network Access Commercial |
$7,504.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,996.79
|
| Rate for Payer: Quartz Commercial |
$5,301.87
|
| Rate for Payer: Quartz Medicare Advantage |
$4,894.03
|
| Rate for Payer: The Alliance Commercial |
$4,078.36
|
| Rate for Payer: WEA Trust Commercial |
$4,486.20
|
| Rate for Payer: WPS Commercial |
$6,041.46
|
|
|
BLADDER SLING TVT GYNECARE RETROPUBIC TENSION-FREE SUPPORT WITH ABDOMINAL GUIDE 810041A
|
Facility
|
IP
|
$7,843.00
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
2965768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,996.79 |
| Max. Negotiated Rate |
$7,504.18 |
| Rate for Payer: Aetna Commercial |
$7,341.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,014.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,323.06
|
| Rate for Payer: Cash Price |
$2,352.90
|
| Rate for Payer: Cigna Commercial |
$7,504.18
|
| Rate for Payer: Health EOS Commercial |
$7,259.48
|
| Rate for Payer: HFN Commercial |
$7,504.18
|
| Rate for Payer: Multiplan Commercial |
$6,525.38
|
| Rate for Payer: Preferred Network Access Commercial |
$7,504.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,996.79
|
| Rate for Payer: Quartz Commercial |
$4,894.03
|
| Rate for Payer: WEA Trust Commercial |
$4,486.20
|
| Rate for Payer: WPS Commercial |
$6,041.46
|
|
|
BLADDER TUMOR, TRANSURETHRAL RESECTION
|
Facility
|
OP
|
$5,017.00
|
|
| Hospital Charge Code |
2960458
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,460.95 |
| Max. Negotiated Rate |
$4,800.27 |
| Rate for Payer: Aetna Commercial |
$4,695.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,487.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,460.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,391.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,608.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,504.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,765.37
|
| Rate for Payer: Cash Price |
$1,505.10
|
| Rate for Payer: Cigna Commercial |
$4,800.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,919.89
|
| Rate for Payer: Health EOS Commercial |
$4,643.74
|
| Rate for Payer: HFN Commercial |
$4,800.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,913.26
|
| Rate for Payer: Multiplan Commercial |
$4,174.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,130.61
|
| Rate for Payer: Preferred Network Access Commercial |
$4,800.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,556.66
|
| Rate for Payer: Quartz Commercial |
$3,391.49
|
| Rate for Payer: Quartz Medicare Advantage |
$3,130.61
|
| Rate for Payer: The Alliance Commercial |
$2,608.84
|
| Rate for Payer: WEA Trust Commercial |
$2,869.72
|
| Rate for Payer: WPS Commercial |
$3,864.60
|
|
|
BLADDER TUMOR, TRANSURETHRAL RESECTION
|
Facility
|
IP
|
$5,017.00
|
|
| Hospital Charge Code |
2960458
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,556.66 |
| Max. Negotiated Rate |
$4,800.27 |
| Rate for Payer: Aetna Commercial |
$4,695.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,487.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,765.37
|
| Rate for Payer: Cash Price |
$1,505.10
|
| Rate for Payer: Cigna Commercial |
$4,800.27
|
| Rate for Payer: Health EOS Commercial |
$4,643.74
|
| Rate for Payer: HFN Commercial |
$4,800.27
|
| Rate for Payer: Multiplan Commercial |
$4,174.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,800.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,556.66
|
| Rate for Payer: Quartz Commercial |
$3,130.61
|
| Rate for Payer: WEA Trust Commercial |
$2,869.72
|
| Rate for Payer: WPS Commercial |
$3,864.60
|
|
|
BLADE 10MM FLEXIBLE OSTEOTOME 71369210
|
Facility
|
IP
|
$1,615.00
|
|
| Hospital Charge Code |
2965974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$823.00 |
| Max. Negotiated Rate |
$1,545.23 |
| Rate for Payer: Aetna Commercial |
$1,511.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,444.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.19
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$1,545.23
|
| Rate for Payer: Health EOS Commercial |
$1,494.84
|
| Rate for Payer: HFN Commercial |
$1,545.23
|
| Rate for Payer: Multiplan Commercial |
$1,343.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,545.23
|
| Rate for Payer: Quartz Beloit One Network |
$823.00
|
| Rate for Payer: Quartz Commercial |
$1,007.76
|
| Rate for Payer: WEA Trust Commercial |
$923.78
|
| Rate for Payer: WPS Commercial |
$1,244.03
|
|
